Prostate Cancer is the most common internal cancer affecting Australian men. It accounts for nearly one quarter of all new cancers diagnosed in men each year, and nearly 3500 men die from prostate cancer in Australia each year.
While prostate cancer and BPH are both conditions that occur more commonly as men get older, there is no direct relationship between the two, in other words, prostate enlargment doesn’t cause prostate cancer. Another important fact to note is that unlike BPH, prostate cancer doesn’t usually cause any urinary symptoms.
For this reason, it is essential that men discuss prostate cancer testing with their local doctor, particularly men between the ages of 40 and 70 years of age. If you have a family history of prostate cancer, in a close relative (a brother or father) there is definitely an increased risk of developing prostate cancer yourself. More recent research has shown that some men with close female relatives who have had breast cancer are also at an increased risk of developing prostate cancer.
At present, there is no simple blood test that will accurately diagnose prostate cancer, but a commonly available blood test known as PSA, can help doctors identify many men who are at an increased risk of having an early prostate cancer. Interpreting a PSA test isn’t always straightforward, but it is the best test currently available for finding men with early, and potentially curable prostate cancer, so men should discuss this test with their local doctor. Most men only need to have a PSA blood test once yearly. Prostate assessment, known as digital rectal examination (DRE) is a quick test that may also provide some useful information about your prostate gland. If there is concern about your PSA test or DRE, or if you require further advice regarding prostate cancer testing, your local doctor should send you to see a specialist Urological Surgeon.
One of the newer imaging tests that is being used to help doctors find early cancers is a multiparametric MRI scan of the prostate. This is a very specialised test that should really only be performed on the advice of a Urological Surgeon. Only July 1, 2018, the Federal Government introduced a Medicare rebate for this test, for patients who satisfy specific clinical criteria, and who are referred by a Urological Surgeon. If your local doctor has referred you for an opinion about prostate cancer testing, your specialist will discuss the role of an MRI scan in your case. While MRI has been a significant advance in helping to find men with early prostate cancer, it should be noted that it is not always perfect, and may miss some cancers. In addition, if there is suspicion of a cancer on an MRI scan this must be confirmed with a prostate biopsy.
Prostate biopsy involves taking multiple very small specimens from the prostate gland using a special device called a core biopsy needle. An ultrasound probe, placed in the rectum, is used to visualise the prostate gland during the biopsy process, so that specific areas in the prostate can be sampled, especially if the patient has had an MRI showing an abnormal region in the prostate. It is a minor procedure that can be performed under local anaesthetic, sedation or general anesthetic, depending on the way in which the biopsies are taken.
If you are diagnosed with prostate cancer, there may be more than one way of managing your condition. Early stage prostate cancer generally has a very high cure rate. However, many factors need to be taken into account when advising a man about prostate cancer treatment including:
- Grade of cancer (slow growing cancers are referred to as ‘low grade’, faster growing or more aggressive cancers are called ‘high grade’ )
- Amount of cancer (how much cancer was found on biopsy)
- PSA level before the biopsy was performed
- Stage of the cancer (whether the cancer is still localised to the prostate or has spread to other parts of the body)
- Patient age, and their general state of health
- Benefits, side-effects and risks of different treatments
- Which treatment the patient feels most comfortable with
Therefore, it is important to take the time to discuss your cancer with your specialist, and make sure that you fully understand why a particular form of management is being recommended.
Early prostate cancer may be managed in one of three ways:
Active surveillance-this is not an actual treatment for prostate cancer but is a safe form of managing some men who have been diagnosed with a very small amount of low grade (slow-growing) prostate cancer. In this situation, the cancer is not considered to pose any significant risk to the patient, so instead of treating it, it is carefully monitored, and treated if or when there is evidence of it starting to progress. Active surveillance aims to avoid the side-effects of unnecessary prostate cancer treatments. Monitoring involves a combination of regular PSA testing, as well as MRI and repeat biopsies, as advised by your Urological Surgeon. If you have been advised to consider active surveillance, you need to have a clear understanding of how your cancer will be monitored, and be diligent in following the advice your specialist has given you. Active surveillance must be directly supervised by a specialist, not your local doctor.
Radical prostatectomy-this is the most definitive form of treatment for prostate cancer, with a cure rate in the order of 80-90 percent. This surgery involves removing the entire prostate gland, and reconstructing the urinary tract so that men pass urine through the normal channel, the urethra. After this surgery, you will no longer ejaculate any semen, but in many cases sexual function can otherwise be maintained. Surgery can effectively and safely be performed as an ‘open’ or ‘radical retropubic prostatectomy‘, or by using an advanced form of ‘keyhole’ surgery called ‘robot-assisted laparoscopic radical prostatectomy‘. While permanent penile erection problems, and to a much lesser extent, permanent urinary leakage, can occur after this surgery, Dr Patel aims to minimise these risks with experienced and meticulous surgical techniques, and by using the very latest operative technology. Radical prostatectomy is considered the best treatment for younger men, who are relatively fit and healthy, and who have a high likelihood that their cancer is confined to their prostate gland.
Radiotherapy-aims to treat prostate cancer without the need for major surgery. While there are different techniques of delivering this treatment, most patients are treated with external beam therapy, which involves focussing powerful X-rays at the prostate gland from outside the body to try to kill the cancer cells in the prostate. The treatment is delivered in “fractions” during daily hospital visits, over a period of 6-8 weeks. It is a very good treatment option for men who are older, or who have serious health problems that would make prostate cancer surgery more risky. It is also suitable for men where there is significant concern that the cancer may not be fully removed by surgery, and is sometimes given after surgery in some men with ‘high risk’ prostate cancers. Radiotherapy can result in penile erectile problems, permanent bowel or bladder irritation or bleeding, and there is an incidence of some men developing bladder cancer as a result of radiotherapy to the prostate.